<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Domain_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-domain_name" class="form-control" name="row[domain_name]" type="text" value="{$row.domain_name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Main_domain')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-main_domain" class="form-control" name="row[main_domain]" type="text" value="{$row.main_domain|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Last_ip')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-last_ip" class="form-control" name="row[last_ip]" type="text" value="{$row.last_ip|htmlentities}">
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Access_ip')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-access_ip" class="form-control" name="row[access_ip]" type="text" value="{$row.access_ip|htmlentities}">
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Record_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-record_id" class="form-control" name="row[record_id]" type="text" value="{$row.record_id|htmlentities}">
        </div>
    </div>


    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
